Abstract
Cardiovascular disease is the most common cause of death in the world. In severe cases, replacement or revascularization using vascular grafts are the treatment options. While several synthetic vascular grafts are clinically used with common approval for medium to large-caliber vessels, autologous vascular grafts are the only options clinically approved for small-caliber revascularizations. Autologous grafts have, however, some limitations in quantity and quality, and cause an invasiveness to patients when harvested. Therefore, the development of small-caliber synthetic vascular grafts (<5 mm) has been urged. Since small-caliber synthetic grafts made from the same materials as middle and large-caliber grafts have poor patency rates due to thrombus formation and intimal hyperplasia within the graft, newly innovative methodologies with vascular tissue engineering such as electrospinning, decellularization, lyophilization, and 3D printing, and novel polymers have been developed. This review article represents topics on the methodologies used in the development of scaffold-based vascular grafts and the polymers used in vitro and in vivo.
Highlights
Cardiovascular disease (CVD) is a group of diseases related to the heart and vasculature including coronary, cerebral, and peripheral artery disease [1, 2], and was responsible for 15.2 million deaths in 2016 according to the World Health Organization, being the major cause of death throughout the world [3]
Because of the urgency of cardiac surgery and the huge number of patients with different backgrounds, the most demanded and desired TEVG, from a cardiac surgeon’s point of view, would be a versatile off-the-shelf, small caliber graft. This goal is challenging, cell-free scaffold-based application is a promising approach as a variety of biocompatible polymers are available
In addition to synthetic polymers, and his group have recently developed a method to create a cell-free textile using in vitro normal human fibroblast culture system [127]
Summary
Cardiovascular disease (CVD) is a group of diseases related to the heart and vasculature including coronary, cerebral, and peripheral artery disease [1, 2], and was responsible for 15.2 million deaths in 2016 according to the World Health Organization, being the major cause of death throughout the world [3]. Because of the absence of alternative autologous grafts and an adequate patency rate, large-caliber (10–30 mm) synthetic grafts have predominantly been developed. Through a large number of trials with a variety of materials, PET (Dacron R ), expanded polytetrafluoroethylene (ePTFE), and polyurethane (PU) are clinically approved nowadays (Table 1) [14]. These materials are mechanically and biologically compatible with native blood vessels. In order to overcome these problems and create a clinically practicable small-caliber graft, innovative methodologies have been developed for vascular tissue engineering such as electrospinning, decellularization, lyophilization, and 3D printing. The main results that had already been obtained in in vivo studies of vascular tissue engineering (VTE) have been highlighted
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